Parkinson and dementia disease: Parkinson’s Disease and Dementia | Johns Hopkins Medicine
Parkinson’s Disease and Dementia | Johns Hopkins Medicine
What is Parkinson disease?
Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinson’s disease also have tremors and may develop cognitive problems, including memory loss and dementia.
Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.
Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.
What causes Parkinson disease?
Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.
What are the symptoms of Parkinson disease?
Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:
- Tremors that affect the face and jaw, legs, arms, and hands
- Slow, stiff walking
- Trouble maintaining balance
- Problems with coordination
- A stiff feeling in arms, legs, and torso area
- Changes in handwriting
Eventually, Parkinson disease symptoms get worse and include:
- Gastrointestinal problems (like constipation)
- Problems with urination
- Trouble chewing and swallowing food
- Memory loss
- Weight loss
How is Parkinson disease diagnosed?
Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.
How is Parkinson disease treated?
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
What are the complications of Parkinson disease?
Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.
Parkinson disease dementia can cause problems with:
- Speaking and communicating with others
- Problem solving
- Understanding abstract concepts
- Paying attention
If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts don’t understand how or why dementia often occurs with Parkinson disease. It’s clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.
Can Parkinson disease be prevented?
Experts don’t yet understand how to prevent Parkinson disease. In some instances, there seems to be a genetic predisposition to develop Parkinson disease, but this isn’t always the case. Research is underway to find new ways to treat and prevent the disease.
Living with Parkinson disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
When should I call my healthcare provider?
Call your healthcare provider if you or your loved one notices a sudden or significant change in symptoms or if mood changes, increased symptoms of depression or feelings of suicide develop.
Key points about Parkinson disease
- Parkinson disease is a movement disorder that can make your muscles tight and rigid.
- It can make walking and taking care of yourself difficult.
- It can lead to problems such as depression, hallucinations, and dementia.
- Parkinson disease will progress but medicines can help with some symptoms.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Lewy body dementia – Symptoms and causes
Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimer’s disease. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).
Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention. Other effects include Parkinson’s disease signs and symptoms such as rigid muscles, slow movement, walking difficulty and tremors.
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Lewy body dementia signs and symptoms can include:
- Visual hallucinations. Hallucinations — seeing things that aren’t there — might be one of the first symptoms, and they often recur. People with Lewy body dementia might hallucinate shapes, animals or people. Sound (auditory), smell (olfactory) or touch (tactile) hallucinations are possible.
- Movement disorders. Signs of Parkinson’s disease (parkinsonian signs), such as slowed movement, rigid muscles, tremor or a shuffling walk can occur. This can lead to falling.
- Poor regulation of body functions (autonomic nervous system). Blood pressure, pulse, sweating and the digestive process are regulated by a part of the nervous system that is often affected by Lewy body dementia. This can result in sudden drops in blood pressure upon standing (orthostatic hypotension), dizziness, falls, loss of bladder control (urinary incontinence) and bowel issues such as constipation.
- Cognitive problems. You might have thinking (cognitive) problems similar to those of Alzheimer’s disease, such as confusion, poor attention, visual-spatial problems and memory loss.
- Sleep difficulties. You might have rapid eye movement (REM) sleep behavior disorder, which can cause you to physically act out your dreams while you’re asleep. This might involve behavior such as punching, kicking, yelling and screaming while sleeping.
- Fluctuating attention. Episodes of drowsiness, long periods of staring into space, long naps during the day or disorganized speech are possible.
- Depression. You might develop depression.
- Apathy. You might lose motivation.
Lewy body dementia is characterized by the abnormal buildup of proteins into masses known as Lewy bodies. This protein is also associated with Parkinson’s disease. People who have Lewy bodies in their brains also have the plaques and tangles associated with Alzheimer’s disease.
A few factors seem to increase the risk of developing Lewy body dementia, including:
- Age. People older than 60 are at greater risk.
- Sex. Lewy body dementia affects more men than women.
- Family history. Those who have a family member with Lewy body dementia or Parkinson’s disease are at greater risk.
Lewy body dementia is progressive. Signs and symptoms worsen, causing:
- Severe dementia
- Aggressive behavior
- Increased risk of falling and injury
- Worsening of parkinsonian signs and symptoms, such as tremors
- Death, on average about seven to eight years after symptoms start
Lewy body dementia care at Mayo Clinic
June 08, 2021
- Dementia with Lewy bodies information page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia-Lewy-Bodies-Information-Page. Accessed Feb. 15, 2021.
- Farlow MR. Clinical features and diagnosis of dementia with Lewy bodies. https://www.uptodate.com/contents/search. Accessed Feb. 15, 2021.
- AskMayoExpert. Dementia with Lewy bodies (adult). Mayo Clinic; 2020.
- Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: A nested case-control study. JAMA Internal Medicine. 2019; doi:10.1001/jamainternmed.2019.0677.
- Diagnosing and managing Lewy body dementia: A comprehensive guide for healthcare professionals. Lewy Body Dementia Association. https://www.lbda.org/healthcare-professionals/. Accessed Feb. 15, 2021.
- Understanding behavioral changes in dementia. Lewy Body Dementia Association. https://www.lbda.org/understanding-behavioral-changes-in-dementia/. Accessed Feb. 16, 2021.
- Taylor J-P, et al. New evidence of management of Lewy body dementia. Lancet Neurology. 2020; doi:10.1016/S1474-4422(19)30153-X.
- Riggin EA. Allscripts EPSi. Mayo Clinic. Jan. 20, 2021.
- Press D, et al. Management of neuropsychiatric symptoms of dementia. https://www.uptodate.com/search/contents. Accessed Feb. 15, 2021.
- McKeith IG, et al. Research criteria for the diagnosis of prodromal dementia with Lewy bodies. Neurology. 2020; doi:10.1212/WNL.0000000000009323.
- Graff-Radford J (expert opinion). Mayo Clinic. Feb. 25, 2021.
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Memory & Thinking Changes | Parkinson’s Disease
Thinking and memory (cognitive) symptoms are are common in Parkinson’s, but not everyone experiences them. In some people, they are mild and don’t impact work or daily activities. This is called “mild cognitive impairment.” In others, they are more significant and affect the everyday activities of both the person experiencing them and their care partner. This is classified as “dementia.” There are different aspects of thinking and memory, and people with Parkinson’s most commonly notice difficulty with:
- Paying attention or concentrating
examples: reading a book, participating in group conversations
- Multitasking and problem solving (executive function)
examples: juggling multiple ongoing projects, figuring out solutions such as how to reroute through a traffic jam or what to do for dinner when you have no ingredients on hand
- Seeing information three dimensionally (visuospatial skills)
examples: making a mental map to walk around the neighborhood and back, judging distance between your car and the one in front of you while driving
No matter when and how significantly Parkinson’s affects cognition, it tends to impact attention and executive function more than memory.
Mild Cognitive Impairment
Mild cognitive impairment (MCI) is a change in thinking or memory that is more than expected with normal aging but is not enough to interfere with a person’s daily activities. People with MCI may feel distracted or disorganized or lose their train of thought. They might find it more challenging to concentrate or manage multiple tasks at once.
As with all Parkinson’s symptoms, treatment of MCI is individualized. Doctors typically recommend that you keep your brain active (See: Boosting Brain Health) and work with an occupational therapist, speech therapist or cognitive rehabilitation specialist to strengthen cognitive skills and manage your specific challenges. (Your physician can refer you to one of these experts.) Your doctor also will look for and treat any medical condition, such as a urinary tract infection, depression or sleep problem, which could potentially worsen cognition. (See: Testing.) At the current time, there are no U.S. Food and Drug Administration (FDA)-approved medications to treat mild cognitive impairment, but research in this area is ongoing.
Estimates vary, but approximately 25 percent of people with Parkinson’s experience MCI. Mild cognitive impairment could stay the same, get better or worsen over time. In some people, MCI gradually progresses to dementia.
Dementia is a broad term for a change in thinking or memory that is significant enough to interfere with daily routines, work or social activities. If dementia occurs in Parkinson’s disease, it’s typically after many years or decades of living with disease.
People with Parkinson’s disease dementia (PDD) experience many of the same symptoms as those with mild cognitive impairment, but to a more considerable degree. Because they have problems with attention and executive function, they may have difficulty planning and completing activities and may take longer to process information and respond to questions. They may have trouble finding words, get lost in familiar places and be more easily confused.
Parkinson’s disease dementia shares symptoms and brain changes (alpha-synuclein protein clumps called Lewy bodies) with a related disease called dementia with Lewy bodies (DLB). These two diseases — PDD and DLB — are grouped under the umbrella term Lewy body dementia. Lewy body dementia causes thinking and memory changes (dementia) and movement symptoms (tremor, slowness, stiffness, and walking and balance problems). It also can lead to hallucinations (seeing things that aren’t there), delusions (false, often paranoid, beliefs), fluctuations in attention and alertness (being “with it” one day and “out of it” the next), and sleep, mood and behavioral changes.
Because of their similarities, doctors and researchers distinguish PDD and DLB primarily based on when movement symptoms and dementia arise. People with Parkinson’s disease dementia start with movement symptoms and many years, or decades, later develop dementia. In dementia with Lewy bodies, the movement symptoms and dementia begin at the same time or within a year of each other.
Not everyone with Parkinson’s experiences dementia. Estimates vary, but about 40 percent of people with Parkinson’s have PDD, and small studies suggest this number may be higher in people who have had Parkinson’s for 20 years or more. Certain factors may increase risk for dementia: a longer course of PD, significant movement problems (more walking and balance problems rather than tremor), mild cognitive impairment, seeing things that aren’t there (hallucinations) or believing things that aren’t true (delusions).
Medications can ease symptoms and improve quality of life, but none has yet been proven to slow or stop disease progression. Symptoms and their commonly used treatments include:
Parkinson’s Disease and Parkinson’s Dementia
alzheimer’s disease & dementia
A diagnosis of Parkinson’s can be devastating, even more so if you’re at risk for Parkinson’s dementia.
But there is hope—and these tips can help.
What is Parkinson’s disease?
Parkinson’s disease (PD) is a progressive disorder of the central nervous system resulting from nerve cells in the brain not producing enough of the chemical dopamine, which regulates movement. It develops gradually, often starting on one side of the body as a slight tremor in one hand, for example. As the disorder progresses, the trembling may spread to both sides of the body and be accompanied by other symptoms such as muscle rigidity, slowing of movement, and deterioration in balance and coordination. While there is no cure for Parkinson’s disease, there are medications and other types of treatment available to address the symptoms.
While most symptoms of Parkinson’s disease involve the disruption of motor functions (muscle and movement), not everyone experiences all the symptoms—even the most common ones like tremors. The way the disease progresses also varies greatly from person to person. For some people, lack of energy, pain, and changes to mood and memory can also occur as part of the disease. And as the disease progresses, some people will eventually experience Parkinson’s disease dementia (PDD), including loss of memory and other cognitive functions.
A diagnosis of Parkinson’s disease can be extremely distressing, for both you and your family. You may be worried about what the future will bring and how you will manage. The potential of developing Parkinson’s disease dementia will only increase these anxieties and concerns. But no matter your situation or stage of the disease, there are many things you and your loved ones can do to manage your symptoms, maintain your independence, and help you to continue enjoying a fulfilling life.
Signs and symptoms of Parkinson’s disease
The primary symptoms of Parkinson’s disease are:
Tremors or shaking often occur in the hands, fingers, forearms, feet, mouth, or chin. Typically, the tremor appears (or gets worse) when your limbs are at rest as opposed to when you’re moving. Some people notice that their tremor is exacerbated by stress and excitement.
Slowed movement (bradykinesia). You may find that your ability to move freely and spontaneously is reduced or slowed down. Repetitive movements can be especially difficult, causing problems with everyday tasks like buttoning a shirt, brushing your teeth, or cutting food. You may start to walk with short, shuffling steps, or your feet may start to drag.
Rigidity, or muscle stiffness, may occur in any part of your body (but most commonly in the neck, shoulders, and legs). This can limit your range of motion and cause muscle pain that gets worse when you move.
Poor balance, or the tendency to be unstable when standing upright, is one of the most important signs of Parkinson’s. It happens because of the loss of reflexes needed for maintaining posture. Some people develop a tendency to sway backwards when standing or turning, which can result in backwards falls.
Secondary symptoms of Parkinson’s disease
In addition to the major symptoms of Parkinson’s, there are many secondary motor symptoms associated with the disease. Again, not everyone with Parkinson’s will necessarily develop all or even any of these symptoms.
- Freezing when walking, usually occurring when taking the first step.
- Small, cramped handwriting that gets worse the more you write.
- A less expressive face. People may comment that you look serious or mad. You may have a blank stare or blink less often.
- Speech may become slow, whispery, or slurred.
- Emotional changes such as anxiety, depression, and fear.
- Fatigue and loss of energy.
- Loss of sense of smell.
- Trouble chewing or swallowing, drooling and excess saliva.
- Sleep problems, including waking up frequently during the night or suddenly falling asleep during the day.
What is Parkinson’s disease dementia (PDD)?
Parkinson’s disease dementia (PDD) is a brain disorder that occurs in some—but not all—people living with Parkinson’s disease. The brain cell damage caused by the disease can lead to a loss of memory and other cognitive functions such as problem solving and speed of thinking. These changes in thinking and behavior can impact your daily living, independence, and relationships.
In those who do develop Parkinson’s disease dementia, there is at least one year—and usually 10 to 15 years—between the Parkinson’s diagnosis and the onset of dementia. According to estimates by the Alzheimer’s Association, 50% or more of people with Parkinson’s disease eventually experience dementia, although there are a number of risk factors that impact the likelihood of developing symptoms:
- Parkinson’s patients who experience hallucinations, excessive daytime sleepiness, and more severe motor control problems are at higher risk for dementia.
- Dementia is more common in people who are older (age 70+) at onset of Parkinson’s.
- Dementia is a bigger risk factor in non-tremor predominant Parkinson’s.
- Overwhelming stress, cardiovascular disease, and adverse reactions to the Parkinson’s disease drug levodopa can also indicate an increased risk for developing dementia.
- Dementia is relatively rare in people who develop Parkinson’s before age 50, no matter how long they have had the disease.
It’s important to remember that progression of Parkinson’s disease dementia can vary greatly from patient to patient. And while there no treatments to slow the rate of damage to brain cells caused by PDD, medications can help to ease symptoms. There are also self-help strategies that can help you maintain a full and rewarding life for as long as possible.
Signs and symptoms of PDD
Common signs and symptoms of Parkinson’s disease dementia include:
- Poor memory and concentration
- Slowed thinking
- Disorientation and confusion
- Delusions and paranoia
- Lack of motivation
- Trouble interpreting visual information
- Problems with planning and decision making
- Moodiness, irritability, and anxiety
- Visual hallucinations
If you’ve noticed some of the above signs and symptoms in yourself or a loved one, it’s important to get them checked out. But don’t jump to conclusions. People with Parkinson’s often experience cognitive changes such as anxiety, lack of motivation, and slowed thinking. These symptoms do not automatically mean dementia.
Is the dementia caused by Parkinson’s or something else?
Indications that dementia may be caused by something other than Parkinson’s disease include agitation, delusions (strongly held false beliefs), and language difficulties. If the onset of cognitive symptoms is sudden, they’re more likely due to something other than Parkinson’s disease—even reversible causes such as infection, a vitamin B12 deficiency, or an underactive thyroid gland.
Depression can mimic dementia by causing similar symptoms such as apathy, memory problems, and concentration difficulties. Since depression is very common in Parkinson’s patients, it’s important to recognize the signs and symptoms of depression in older adults.
Parkinson’s disease dementia vs. other dementias
Other types of dementia that can be commonly mistaken for Parkinson’s disease dementia include:
Lewy Body Dementia is characterized by fluctuations in alertness and attention, recurrent visual hallucinations, and Parkinsonian motor symptoms like rigidity and the loss of spontaneous movement. In this disorder, cognitive problems such as hallucinations tend to occur much earlier in the course of the disease (within a year of the onset of Parkinson’s disease) and often precede difficulties with walking and motor control.
Alzheimer’s disease and Parkinson’s disease are both common in the elderly, especially in those over 85. Patients with Parkinson’s who develop dementia may even develop Alzheimer’s dementia as well. Therefore, it’s important to be aware of the signs of Alzheimer’s Disease and how it’s treated.
The similarities in symptoms between Parkinson’s disease dementia, Lewy Body Dementia, and Alzheimer’s disease, can make it difficult to determine the cause of the symptoms. Thus, obtaining a thorough consultation with a neurologist may be necessary to make a definitive diagnosis and establish an appropriate plan of care.
Coping with a Parkinson’s diagnosis
A diagnosis of Parkinson’s can be a frightening experience for both you and your loved ones. While there is currently no cure, there are treatments available for Parkinson’s symptoms and lifestyle changes you can make to slow the progression of the disease and delay the onset of more debilitating symptoms, including Parkinson’s disease dementia. Early diagnosis can prolong independence and help you to live life fully for much longer.
If you’ve been diagnosed with Parkinson’s you may feel anger, deep sadness, or fear about what the future will bring. These feelings are all normal. It’s also normal to grieve as you deal with this enormous adjustment.
Give yourself some time to adjust. As with any major change in life, don’t expect that you will smoothly snap into this new transition. You may feel alright for a while, and then suddenly feel stressed and overwhelmed again. Take time to adjust to this new transition.
Learn all you can about Parkinson’s disease and Parkinson’s disease dementia. Educating yourself and making important decisions early can help you feel more in control during this difficult time.
Reach out for support. Living with Parkinson’s presents many challenges, but there is help available for this journey. The more you reach out to others and get support, the more you’ll be able to cope with symptoms while continuing to enrich and find meaning in your life.
Adopt self-help strategies. Healthy lifestyle choices will not only make you feel better emotionally but may also help improve symptoms, make living with Parkinson’s disease easier, and slow the progression of the disease. Some lifestyle changes may even reduce your risk for or delay the onset of dementia symptoms.
Self-help tip 1: It’s critically important to stay active
Staying active is one of the most important things you can do to maintain your health and quality of life after a Parkinson’s diagnosis. And the sooner you start, the better. Regular exercise or physical activity can significantly slow the progression of the disease and reduce your risk of developing dementia. It can also ease symptoms you’re already experiencing, such as muscle stiffness, posture changes, balance problems, and movement difficulties.
That’s on top of the powerful mental and emotional benefits of exercise. Even small amounts of physical activity can add up to big decreases in depression, anxiety, and stress. The key is to make it a regular part of your routine.
Pay attention to your body. The symptoms of Parkinson’s often fluctuate through the day, so plan your active time around them. You may also find that certain types of exercise work better for you and your symptoms, so experiment. Most importantly, pick something you enjoy so you’ll stick with it.
Take regular “movement breaks.” As getting around and doing things becomes more difficult, it’s only natural to move less, but inactivity makes symptoms worse. Remind yourself to get up—or, at the very least, change position—at least once every hour. And try to avoid too much time sitting in front of the TV, computer, or reading.
See a physical therapist, if possible. Before starting a new exercise regimen, you should always check with your doctor to make sure it’s safe. But for personalized guidance, go to a physical therapist. They can recommend specific exercises and activities tailored to your needs.
Exercise tips for people with Parkinson’s disease
- Regular bending, stretching, and breathing exercises can help you combat posture and balance problems.
- If you’re having trouble or pain while exercising on the floor, try exercising in bed. There are also many chair exercises that can help.
- Don’t underestimate the benefits of walking. It’s convenient and effective. If you’re having trouble, try using a cane or holding onto something (or someone) as you walk.
- Try exercising in the water; it’s easier on the joints. Many fitness centers, hospitals, colleges, and YMCA or YWCA facilities often offer water exercise programs.
- Don’t forget to exercise your face and jaw (sing, read out loud, make exaggerated faces in the mirror). This will help with your facial expressions.
Tip 2: What—and how—you eat can make a difference
There’s no specific Parkinson’s disease diet, but by adjusting your eating habits, you can help protect your brain. Diets that are good for your heart tend to also be good for brain health. Eating habits such as those promoted in the Mediterranean diet can help reduce inflammation, protect neurons, and promote better communication between brain cells.
Primarily, it’s important to eat plenty of fruit and vegetables, cut down on sugary foods and refined carbs, reduce fried and processed foods, and boost your intake of healthy fats and home-cooked meals. High protein meals may also help to benefit your brain chemistry.
Coping with dietary problems
Many people with Parkinson’s experience various eating and dietary problems, such as constipation, chewing and swallowing difficulties, and upset stomach. The following tips can help you minimize the symptoms.
If you suffer from constipation… Drink lots of water and eat fiber-rich foods, including beans, brown rice, whole grains, and fruit.
If you have trouble chewing or swallowing food… Cut foods into smaller portions to avoid choking and to encourage digestion, and remain upright for 30 minutes after eating.
If you’re struggling with fatigue… Limit the amount of sugar you’re eating. Also avoid alcohol and caffeine, especially before bed, as they can reduce the quality of your sleep.
If you take levodopa (Sinemet)… Don’t eat meat or other protein-rich foods for at least 30-60 minutes after taking levodopa, as protein blocks your body’s ability to absorb the medication.
If your medication gives you an upset stomach… Take your medication with a full glass of water and a small non-protein based snack, such as a piece of toast or fruit.
Some Parkinson’s disease medications need to be taken promptly at specified times before or after eating, so it can also help to establish a regular routine for meal and medication times.
Tip 3: Make it a priority to be socially engaged
The more socially active you are, the more you connect face-to-face with others, the stronger your memory and cognition is likely to be. You don’t need to be a social butterfly or the life of the party, but you do need to regularly connect with people who care about you.
Connecting with others is the most effective means of relieving stress which left unchecked can exacerbate symptoms of Parkinson’s disease. Staying socially engaged also stimulates immune function that may slow the progress of disease. While many of us become more isolated as we get older, it’s never too late to meet others and develop new friendships.
Tips for meeting new people
- Join a club or social group
- Visit your local community center or senior center
- Take group classes (such as at the gym or a community college)
- Reach out over the phone or email
- Connect to others via social media
- Get to know your neighbors
- Make a weekly date with friends
- Get out (go to the movies, the park, museums, and other public places)
Tip 4: Make other healthy lifestyle choices
In addition to regular exercise, eating a healthy diet, and interacting with others, there are plenty of other steps you can take to manage Parkinson’s symptoms and lower your risk for dementia.
1. Seek mental stimulation. By continuing to learn new things and challenge your brain, you can strengthen your cognitive skills and stay mentally sharp. Another great way to improve brain function is to learn a new skill, whether it’s a musical instrument, a foreign language, a new computer program, or a new game or sport. Classes at community centers or colleges can help you to tackle new subjects.
2. Improve the quality of your sleep. Good sleep is important for flushing out toxins and protecting your brain. Most adults need 7 to 9 hours of quality sleep. Establish a regular sleep schedule, create relaxing bedtime rituals such as taking a bath or doing some light stretches, and turn off all screens at least one hour before sleep.
3. Manage stress. Unchecked stress takes a heavy toll on the brain, shrinking a key memory area, hampering nerve cell growth, and can make many Parkinson’s symptoms worse. Overwhelming stress may even increase your risk for developing dementia. As well as connecting face-to-face with others, exercise and relaxation techniques such as meditation or deep breathing can help you lower your stress levels.
4. Find ways to contribute or give back. Investing in things that you care about and give your life meaning and purpose can energize the nervous and immune systems and help preserve your health. Continue activities that were important to you before your diagnosis or find new ways to invest yourself. You might consider volunteering for a cause that’s important to you, spending more time with your grandkids, involving yourself in a religious community, or even caring for your pets—anything that makes you feel needed and fulfilled.
5. Nourish your spirit. Do things every day that add joy to your life. Everyone experiences pleasure differently. It could be spending time in nature, enjoying the arts, playing with grandkids or pets, traveling, or enjoying a hobby.
To learn more about putting these strategies into action, see Preventing Alzheimer’s Disease.
Don’t ignore depression
Many people with Parkinson’s disease struggle with depression at some point. If you suspect that you’re depressed (or that your loved one is), it’s important to seek help. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson’s disease. As an older adult, there are plenty of things you can do to change how you feel and boost your mood.
Caring for someone with Parkinson’s
Caring for someone with Parkinson’s disease or dementia can be a rewarding as well as challenging experience. It will likely involve adapting to new challenges over time as the disease progresses or new symptoms emerge.
Become informed. Learn as much as you can about Parkinson’s disease and Parkinson’s disease dementia and how it is likely to affect your loved one specifically, given their health history, age, and lifestyle.
Communicate openly and provide reassurance, especially in the early stages following diagnosis, that Parkinson’s disease is only slowly progressive in most patients and that your loved one can still live a full life.
Modify tasks to allow for greater independence. Allow your loved one to do things for themselves even if it takes longer. If necessary, break tasks that involve fine motor skills into easier steps and focus on success, not failure.
Help your loved one find alternative means of transport if they have to give up driving. That may involve researching public transportation, ride sharing, or community shuttle services.
Exercise together. Exercising is vital for the health and state of mind—of both of you. Take a class together or simply enjoy a walk outside.
Look after yourself. Take regular breaks to avoid caregiver burnout, maintain social ties, and seek out opportunities to relax and have fun. Talking to others in similar situations can be very helpful.
Parkinson’s disease dementia & Lewy Body dementia
What are Parkinson’s disease dementia and Lewy Body dementia?
Parkinson’s disease (PD) is a progressive, degenerative neurological movement disorder that affects approximately 7 million people worldwide. It is the second most common neurodegenerative disorder after Alzheimer’s disease.
Up to 80% of Parkinson’s disease patients will develop Parkinson’s disease dementia (PDD) that is characterized by a progressive loss of memory and decline in intellectual abilities.
About 15% of Parkinson’s disease diagnoses include so-called Parkinson’s plus syndromes. One of these syndromes is Lewy body dementia (LBD), also known as dementia with Lewy bodies (DLB), a form of progressive dementia accounting for 20% of dementias in people over the age of 65.
What are the symptoms of these diseases?
The main symptoms of Parkinson’s disease involve motor control, such as tremor (hands, arms, legs, jaw and face), slowness of movement, stiffness of the limbs and trunk as well as postural instability. Many patients develop a decline in thinking and reasoning known as Parkinson’s disease dementia if it occurs more than one year after the initial diagnosis of Parkinson’s disease. Common symptoms for PDD include decline in memory, concentration and judgment, visual hallucinations, depression, irritability and anxiety.
The central feature of Lewy body dementia (LBD) is progressive cognitive decline, combined with pronounced fluctuations in alertness and attention, complex visual hallucinations and motor symptoms such as rigidity and the loss of spontaneous movement. It can easily be mistaken for Alzheimer’s disease (AD) or for Parkinson’s disease dementia (PDD).
Understanding Parkinson’s disease, PDD and LBD
Parkinson’s disease initially affects neurons in an area of the brain called substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As the disease progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
As Parkinson’s disease progresses, it affects also other brain areas and nerve cells important for mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task.
Parkinson’s disease dementia and dementia with Lewy bodies
The key pathological hallmark found in brains of Parkinson’s disease and Parkinson’s disease dementia patients are abnormal microscopic deposits composed of alpha-synuclein. This protein is found widely in the brain but its normal function is not yet well understood. The deposits are called “Lewy bodies”. Lewy bodies are also found in several other neurodegenerative brain disorders, including dementia with Lewy bodies (LBD). Evidence suggests that Parkinson’s disease and Parkinson’s disease dementia, and dementia with Lewy bodies, may be linked to the same underlying abnormalities in brain processing of alpha-synuclein.
Asceneuron’s innovation in PDD and DLB
Several symptomatic treatments addressing motoric disturbances in PD are currently available. In contrast, there is a very high unmet medical need for novel symptomatic medications to mitigate the cognitive decline in Parkinson’s disease dementia patients, since available options have limited efficacy and considerable side effects. As the disease progresses, balancing the benefits of medications with their side effects becomes challenging for caregivers.
Asceneuron has generated small molecules of novel chemical classes that have the potential to deliver novel, well-tolerated and efficacious drugs to treat learning and memory deficits in dementia. Our positive allosteric modulators of the M1 muscarinic acetylcholine receptor have the potential to bring the first approved treatment for PDD to patients and a new class of molecules for the treatment of dementia in general. M1 PAMs induce a change in the shape of the receptor, enhancing binding to the neurotransmitter acetylcholine. As a result, receptor activity is potentiated so that it can still fulfill its signaling functions, critical for cognition, even in situations where acetylcholine levels are reduced as observed in Parkinson’s disease dementia and other dementia in general.
Given the high unmet medical need in PDD, a symptomatic treatment for one of the more debilitating facets of PD would bring significant benefit to PD patients and their caregivers.
Symptoms, Causes, Diagnosis & Treatment
What is Lewy body dementia (LBD)?
Lewy body dementia (LBD), is a brain disorder in which proteins, called alpha-synucleins, build up inside certain neurons (brain cells). These clumps of proteins, called Lewy bodies, cause damage to neurons in areas of the brain that affect mental capabilities, behavior, movement and sleep.
In elderly patients, LBD is one of the most common causes of dementia. The symptoms of LBD may closely resemble those of other neurological disorders, including Alzheimer’s disease and Parkinson’s disease.
Doctors do not know why you or your loved one develop LBD while others do not. There is no cure for LBD, but your symptoms can be managed with certain medications, like cholinesterase inhibitors (Aricept®, Exelon®, Razadyne®) and levodopa. You or your loved one may also benefit from non-medical treatments like physical therapy and speech therapy.
Who is most at risk for getting Lewy body dementia (LBD)?
While anyone can develop Lewy body dementia (LBD), those most at risk are over the age of 50. Men are slightly more likely to develop LBD than women.
How common is Lewy body dementia (LBD)?
Lewy body dementia (LBD) is one of the most common causes of dementia in older people. It is estimated that as many as 1.4 million people live with this disorder in the U.S. Most diagnoses are in people over the age of 50.
Symptoms and Causes
What causes Lewy body dementia (LBD)?
Lewy body dementia (LBD) is a broad term covering two separate neurological disorders: dementia with Lewy bodies and Parkinson’s disease dementia. The same biological changes to the brain cause both disorders.
A buildup of Lewy bodies (proteins called alpha-synucleins) causes LBD. Lewy bodies build up in neurons located in certain areas of the brain that are responsible for behavior, movement, and cognitive ability.
Doctors do not know why you or your loved one develop LBD while others do not. There is some thought that the combination of mutation in a person’s genes, environmental risk factors and natural aging might lead to the development of LBD in some people. Research into specific causes is ongoing.
What are the symptoms of Lewy body dementia (LBD)?
Lewy body dementia (LBD) symptoms may resemble those of other neurological disorders, like Alzheimer’s disease and Parkinson’s disease. LBD affects each person differently, and symptoms vary in severity.
Common symptoms of LBD include:
- Decline in thinking, including memory, planning, problem solving, decision making and ability to focus and to understand information in visual form.
- Visual hallucinations, or seeing things that are not there.
- Reduced alertness, attention and ability to concentrate.
- Parkinsonism, a movement disorder with symptoms including slowness, tremors, stiffness, balance problems, soft voice, difficulty swallowing, reduced facial expression and shuffling walk.
- Visuospatial difficulties, including decreased depth perception, trouble recognizing familiar objects and impaired hand-eye coordination.
- Delusions, or beliefs with no basis in reality.
- Changes in behavior and mood including anxiety, agitation, aggression, apathy, depression and paranoia.
- Changes in sleep patterns.
Other symptoms include:
- Acting out while sleeping. Your loved one may act out their dreams during a phase of sleep cycle called rapid eye movement (REM). Sometimes this happens years before their LBD diagnosis. Often called REM sleep behavior disorder (RBD), this condition is described as frequent movements, such as flailing or punching, with yelling or speaking while sleeping. People living with RBD often have difficulty separating dreams from reality when they wake up.
- Changes in normal body functions. Body temperature may waver, blood pressure may fluctuate (causing fainting episodes and falls) and loss of bowel and bladder control.
Diagnosis and Tests
How is Lewy body dementia (LDB) diagnosed?
There are no medical tests that can diagnose Lewy body dementia (LBD) with 100% accuracy. Specialists, including neurologists, geriatric psychiatrists, neuropsychologists and geriatricians, make the diagnosis of ‘probable LBD’ based on the combined results of tests and patient symptoms.
Your healthcare provider will perform a thorough neurological and physical examination. You or your loved one will also complete mental status and neuropsychological tests. These tests check thinking abilities, including memory, word-finding, attention and visual-spatial skills. Your doctor will ask you and your family about your mental status and the history of your symptoms. Be sure to tell your healthcare provider of any physical, cognitive, memory, emotional, behavioral, movement, sleep or physical changes you or your loved one is having. Also, tell your healthcare provider about any of your current medications, supplements, vitamins, herbal products and frequently used over-the-counter products. These will be reviewed to see if they might be a cause of your or your loved one’s symptoms.
Depending on your symptoms, your doctor may also test your blood. If your doctor needs more information, brain imaging studies may be performed.
If you have cognitive deficiency severe enough to impair daily life (dementia) in the presence of any following clinical features, your doctor may suspect diagnosis of LBD:
- Changes in cognition, attention and alertness.
- REM sleep behavior disorder.
- Visual hallucinations.
- Movement problems (Parkinsonism).
Some patients with Parkinson’s disease who develop cognitive symptoms more than a year after the onset of movement problems may be diagnosed with Lewy body dementia.
Can imaging tests diagnose Lewy body dementia (LBD)?
Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), are done to rule out other causes of dementia such as brain tumors, brain bleeds, stroke, hydrocephalus or other structural causes. Imaging studies for Lewy body dementia (LBD) are usually normal. The only way to make an absolute diagnosis of LBD is by examining the brain at autopsy.
Management and Treatment
How is Lewy body dementia (LBD) treated? Is there a cure?
There is no cure for Lewy body dementia (LBD). Medications and nonmedical therapies, like physical, occupational and speech therapies, manage symptoms as much as possible.
Medications called cholinesterase inhibitors (Aricept®, Exelon®, Razadyne®) help manage the cognitive symptoms of LBD. Memantine (Namenda®) may also be helpful. Symptoms of Parkinsonism, like tremors, are usually treated with levodopa, a drug commonly used to treat Parkinson’s disease.
You or your loved one may also benefit from treatments like physical therapy or speech therapy. These treatments help retain physical function and improve muscle strength.
What complications are associated with medications used to treat Lewy body dementia (LBD)?
Up to 50% of people living with Lewy body dementia (LBD) can have severe side effects when treated with certain antipsychotic medications. These are known as the typical or traditional antipsychotics and include such drugs as thoridazine, haloperidol, chlorpromazine and perphenazine. This class of older, first-generation antipsychotics can cause sedation and make cognitive symptoms and movement problems (Parkinsonism) worse. A life-threatening reaction to an antipsychotic medication, called neuroleptic malignant syndrome, is possible. Symptoms include rigid muscles, changing blood pressure, high fever, confusion and fast heart rate. Contact your healthcare provider immediately if you or your loved are taking an antipsychotic and develop these symptoms.
Visual hallucinations and behavioral changes may be treated with the newer, atypical antipsychotic medications pimavanserin (Nuplazid®), quetiapine (Seroquel®) or clozapine (Clozaril®). However, because all antipsychotic medications – both older, typical medications and newer atypical medications – can increase the risk of death in elderly patients with dementia, you and your healthcare provider should carefully discuss the risks and benefits and using these medications.
Other medications, like antidepressants or sedative antihistamines, may increase confusion in people with LBD.
Talk with your healthcare provider about all the medications you or your loved one takes. Many drugs have side effects that can worsen symptoms or add to them. If medications to treat symptoms are not working to decrease symptoms, others can be tried. Never hesitate to talk to your healthcare with your concerns or to ask questions.
Can Lewy body dementia (LBD) be prevented?
Currently, there is no known way to prevent Lewy body dementia (LBD).
Outlook / Prognosis
How do lewy bodies actually cause harm in the brain?
Lewy bodies are clumps of a specific protein (alpha synuclein) that build up in the brain. The lewy bodies form in areas in the brain involved in memory, thinking and movement. Technically, the lewy bodies overwhelm brain cells’ (neurons) normal biologic functions, causing cells to die.
What can I expect if I or my loved one have a diagnosis of Lewy body dementia (LBD)?
Each person’s experience with Lewy body dementia (LBD) is unique to them. How slowly or quickly the disease progresses is impossible to know, but may be influenced by your general health and any existing diseases you may have. Because LBD is a progressive disease, difficulties with mind and body functions get worse over time. Currently, there is no known way to stop the progression of the disease. After diagnosis, most people with LBD live between five and seven years. Some people with LBD live up to 20 years after their diagnosis.
However, there’s always hope. Research on LBD, dementia with lewy bodies, Alzheimer’s disease, Parkinson’s disease with dementia are ongoing. New medications are being developed and new approaches to treatment are being investigated.
How can a person diagnosed with Lewy body dementia live the best life possible?
First, it’s important to interact with others as much as possible. Plus exercise and eat a healthy diet to keep mind and body as strong as possible.
Use music and aromatherapy to reduce anxiety and improve mood.
Other things you can do involve seeking the help and assistance of others. Therapists can improve the quality of life of someone living with Lewy body dementia. Therapists include:
- Physical therapists: These therapists can help improve physical strength, flexibility, balance and walking mechanics.
- Occupational therapists: These therapists can teach skills and methods to maintain your ability to perform activities of everyday life and remain independent.
- Speech therapists: These therapists can improve swallowing difficulties and ability to speak more clearly.
Persons with Lewy body dementia and their families can also benefit from counseling with a psychotherapist. This counselor teaches how to manage emotional and behavioral problems. Finally, joining a support group – there are support groups for persons with LBD and for the caregivers of persons with LBD. Support groups help solve day-to-day problems and frustrations through sharing similar experiences. See the resource section of this article for links to support groups.
Is Lewy body dementia an inherited condition?
One of the more recent discoveries toward identifying a cause of Lewy body dementia is the finding of an increasing number of gene mutations. Two genetic risk factors recently discovered are variants in the APOE and GBA genes. APOE is already known to increase the risk of developing Alzheimer’s disease. There is growing evidence that it also increases the risk for dementia with lewy bodies. Similarly, the GBA gene increases the risk for both Parkinson’s disease and dementia with lewy bodies. Despite these findings, genetic changes as a cause of LBD are still considered rare by scientists. Most cases of Lewy body dementia are not thought to be inherited.
Genetic testing for routine screening for LBD is not currently recommended. Discuss the pros and cons of testing with your healthcare providers if you have a family history of multiple members with Parkinson’s disease and/or dementia with lewy bodies.
How exactly is Lewy body dementia related to Alzheimer’s disease and Parkinson’s disease?
Lewy body dementia is a broad, general term for dementia in which lewy bodies are present in the brain. Dementia with lewy bodies and Parkinson’s disease dementia are two related clinical disorders that make up the general broader category of Lewy body dementia. Sometimes LBD is first diagnosed as Parkinson’s disease or Alzheimer’s disease based on its symptoms.
- Parkinson’s disease dementia (PDD): You might be diagnosed with Parkinson’s disease if you start out with a movement disorder typical to Parkinson’s but then have your diagnosis changed to PDD when dementia symptoms develop.
- Alzheimer’s disease (AD): You might start out with memory or cognitive disorder that leads to a diagnosis of AD. Over time, other distinctive symptoms begin to appear and your diagnosis is then changed to dementia with lewy bodies. Distinctive symptoms of LBD include the changes in attention, alertness and cognitive ability; changes in walking and movement; visual hallucinations; REM sleep behavior disorder and severe sensitivity to some antipsychotics used to treat hallucinations.
When should I call my doctor?
If you develop symptoms of Lewy body disease, contact your doctor for a thorough evaluation. Your doctor will develop a treatment plan based on your diagnosis and symptoms.
What resources are available to help people with Lewy body dementia (LBD)?
If you or one of your family members or friends have Lewy body dementia (LBD), you might benefit from seeking additional help. Here are some places to contact:
Dementia in Parkinson’s disease (PDD) – Neurodegenerative diseases – Other forms of dementia – Dementia
by Kurt Jellinger
While people with Parkinson’s disease have a higher risk of developing dementia than those without Parkinson’s disease, the majority will remain unaffected.
Parkinson’s disease is known as a movement disorder. The movement disorder is due to dopaminergic neurons mainly in the substantia nigra.
Motor symptoms always precede cognitive impairment by several years. Cognitive impairment is usually due to degenerative changes in limbic or neocortical structures, superimposed Alzheimer-type lesions and/or presence of cortical Lewy bodies, while degenerative lesions in subcortical neurotransmitter-specific loops are less important for the development of cognitive impairment.
Idiopathic parkinsonism plus dementia
Symptoms and course
Symptoms of dementia associated with Parkinson’s disease will vary from person to person. The most common are memory loss and the loss of the ability to reason and to carry out normal everyday tasks (planning, organising, solving problems). Patients may become obsessional, and there may be a loss of emotional control with sudden outbursts of anger or distress.
Medications may cause or aggravate visual hallucinations.
Language problems (slower speech, not word finding difficulties).
Symptoms often fluctuate so that the person will seem better or worse at different times. Gradually progressive, symptoms accumulate progressively.
Duration of the disease: 4-5 years. Parkinson’s disease plus dementia has shorter survival than Parkinson’s disease without dementia (average between 5 to 10 years).
With movement disorder, slowness in information processing (difficulty of communication) may lead to carer frustration.
Causes and risk factors
Abnormal aggregation of alpha synuclein in Lewy bodies. It is more than Lewy bodies accumulation (often associated with Alzheimer pathology).
Families with familial PD (Several chromosomes involved) There are inherited form of Parkinson’s disease associated with mutation on chromosomes xxx.
Parkinson’s disease is not RARE; however, only 10-30 % of the patients develop cognitive impairment / dementia. Prevalence 41:100,000
Care and treatment
The movement disorder is treated by compounds augmenting dopamine transmission (dopaminergic substances and DA agonists). Medication may cause or aggravate hallucinations and psychotic symptoms. Antidementive drugs like in AD.
Ongoing research/Clinical trials Trials have been conducted on small patient samples demonstrating benefits of Cholinesterase inhibitors on cognitive ability.
European Parkinson’s Disease Association (EPDA) Lizzie Graham EPDA Liaison/Project Manager 4 Golding Road Sevenoaks Kent TN13 3NJ United Kingdom Tel/Fax: +44 (0)1732 457683 [email protected] http://www.epda.eu.com/
Parkinson’s disease associations provide services for the movement disorders but have less information on the cognitive problems associated with the disorder.
In a case of dementia, please refer also to Alzheimer’s disease associations.
Alzheimer Europe 145 Route de Thionville L- 2611 Luxembourg Tel: +352 / 29.79.70 Fax: +352 / 29.79.72 [email protected] www.alzheimer-europe. org
Alzheimer’s Disease International 45-46 Lower Marsh London SE1 7RG United Kingdom Tel: +44 / 20 7620 3011 Fax: +44 / 20 7401 7351 [email protected], www.alz.co.uk
Treatment of dementia in Parkinson’s disease
Psychotherapists of Moscow – latest reviews
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Dementia / Diseases / Clinic EXPERT
What is dementia
Dementia is a collective term used to denote a set of symptoms resulting from various diseases of the brain.It manifests itself as a gradual increase in brain malfunctions, leads to a decrease in a person’s ability to function and, as a result, can lead to disability and death. There are many different types of dementia, but they are all associated with progressive impairments of the following brain functions:
- Perception and processing of information
- Motor coordination.
Dementia can also lead to other mental health problems such as personality changes, persistent anxiety, mood swings, and depression.Sometimes it leads to partial or complete disability of a person, while patients lose the ability to take care of themselves, perform basic self-care and their own life support. Later stages of dementia may be accompanied by refusal to eat, inability to get up and move around.
In the people, senile dementia is called “senile sclerosis” (or senile marasmus, senile dementia). However, these are common names, not scientific terms. Dementia usually affects older people, that is, in most cases it is senile or senile dementia.If the proportion of patients with dementia among people over 65 years old is 5-10%, then after 85 years, every third or fourth person suffers from this disease. However, the number of people under the age of 65 suffering from dementia is also quite large: in Russia alone it amounts to tens of thousands, and in the world more than 50 million people suffer from various types of dementia, according to the World Health Organization (WHO).
In recent years, dementia is increasingly noted among younger people from 30 to 65 years old, which is due, among other things, to the spread of alcoholism and drug addiction.
Dementia in Russia
According to statistics from the authoritative website alz.org dedicated to Alzheimer’s disease, more than 1.5 million people in Russia suffer from dementia. At the same time, the number of patients who have been officially diagnosed with dementia is several times less in our country. This is due, among other things, to the fact that many elderly people who suspect they have dementia do not go to the doctor, because they are afraid of being declared incapacitated and insane, although dementia is not a mental illness.
As a result, a rather sad situation arises when there are a lot of people living in Russian families who suffer from dementia, but do not receive proper treatment and medical care. This situation leads to additional suffering and stress both for the patients themselves and for the people caring for them. Often, dementia, left on its own, turns into a stage where caring for the patient at home becomes extremely difficult, and treatment will be ineffective due to the late stage.
Fortunately, the situation is gradually changing, people are beginning to relate differently to their mental health and the brain health of their elderly relatives. More and more often, in case of memory and thinking impairment, people turn to specialists of the appropriate profile.
If you or your loved one has signs of dementia, then do not self-medicate and do not let the disease take its course, but contact a qualified neurologist.
Types of dementia
There are about a hundred different types of dementia caused by various pathological processes in the brain.Major pathologies:
- Alzheimer’s disease, which causes dementia in about 2/3 of patients
- vascular dementia, accounting for 20-30% of cases.
According to some estimates, vascular dementia in Russia may even outstrip Alzheimer’s disease in prevalence, which is associated with a high level of alcohol consumption and smoking.
Alzheimer’s disease is manifested by the death of neurons caused by metabolic disorders in the brain. Vascular dementia is caused by insufficient blood supply to neurons due to disturbances in the circulatory system of the brain.Mixed forms are also observed, in which two diseases develop simultaneously.
What Causes Dementia
Causes of Alzheimer’s Disease
It is believed that most cases of dementia are caused by a complex interaction of genetic predisposition, lifestyle and environmental influences. In neurodegenerative types of dementia, there is a gradual accumulation of specific proteins around nerve cells, which leads to their death. The mechanisms behind neuronal death in Alzheimer’s disease are still unknown, which is why the disease remains incurable.
Causes of vascular dementia
Vascular dementia develops when the arteries that supply blood to the brain are blocked. Oxygen and food starvation of brain cells occurs, which leads to micro-strokes, causing brain damage and the development of dementia. Various diseases can also lead to dementia, such as Parkinson’s disease, multiple sclerosis, alcoholism, and Creutzfeldt-Jakob disease.
The following symptomatic manifestations are characteristic of dementia:
- The tendency to repeat actions.Has anyone asked you the same question many times during the conversation? Or maybe at each meeting he told the same news from the recent past? Or have you watched how a person brushes his teeth several times a day, makes the bed, shifts things from place to place? This could be a sign of dementia.
- Loss of sense of direction and orientation. People with dementia are often unable to recognize landmarks, forget the way home or the appearance of their home.
- Apathy, lethargy when communicating with friends and loved ones, indifference to previous hobbies and activities that previously aroused interest.
- Deterioration of short-term memory. People with dementia sometimes remember very well the smallest details of past events, but forget what happened during the day (what they ate, whether they took a shower, etc.). However, it should be remembered that forgetfulness can also be observed in healthy people.
- Problems with the perception of the plot of the film, program, book, story. Patients with dementia often cannot keep track of the logic of the narrative, get confused, cannot track the development of the plot.
- Deterioration of communication skills, forgetting familiar faces and names, placing household items in a wrong place.Decreased vocabulary and difficulties in formulating thoughts can lead to a deterioration in communication skills. The inability to formulate one’s thoughts entails stress, which further impairs the patient’s communication with others.
- Mood swings. Dementia can affect a person’s ability to assess and respond to their environment. The former quiet ones can, to the surprise of others, become assertive, and some, who were very active earlier, begin to show signs of depression, become lethargic.
- Dizziness and headache. Some forms of dementia are associated with impaired circulation in the vessels of the brain, which leads to dizziness and migraines.
Risk factors for dementia
Researchers continue to study the risks of dementia. Among the factors that can increase the risk of developing dementia, the following are currently known:
- physical inactivity
- drinking a significant amount of alcohol
- head injuries
- genetic predisposition
- unbalanced diet
- living in areas with an unfavorable environmental situation.
Making a diagnosis
There is no universal test for detecting dementia. It is quite difficult to detect it, especially in the early stages. Often, a long series of examinations is required in order to make a correct diagnosis based on the dynamics of the patient’s condition. Among the assigned studies there are laboratory and instrumental types of diagnostics (MRI, CT, PET, ultrasound and others). A number of cognitive (psychological) tests are also carried out, the purpose of which is to assess the state of memory and thinking of the subject.There are a number of diseases that resemble dementia, so differential diagnosis is highly relevant.
Difficulties in diagnosing dementia lead to the fact that many families live with this problem without even knowing about it.
Early diagnosis of this disease is doubly important, since it is at this stage that the chances of successful treatment are highest. If the disease has passed to an advanced stage, then the chances of successful treatment are small, since it is extremely difficult to reverse pathological changes in the nervous system.
According to statistics, the treatment of dementia is effective in about 30% of cases. Despite all the efforts of the medical community, there are no effective treatments for most types of dementia. This primarily applies to the most common type of dementia – Alzheimer’s disease.
However, there are drugs and techniques that allow in some cases to slow down the progression of various types of dementia and alleviate the patient’s condition.
The recommendations of the attending physician can reduce the unpleasant manifestations of the disease and slow down its progression. Palliative therapy, that is, it relieves suffering, helps to eliminate such concomitant manifestations as depression, anxiety, panic attacks and sleep disturbances. If left untreated, these manifestations increase the progression of dementia. Therapy for these types of disorders can break the vicious circle and resist the development of dementia. All these actions will facilitate not only the condition of the patient himself, but also his loved ones caring for him, help to fight stress and discomfort.
In addition to drug therapy, the attending physician can recommend various lifestyle changes: certain types of physical activity, diet, a set of intellectual exercises to maintain memory.
Prevention of dementia
There is no guaranteed way to prevent dementia. However, certain preventive measures reduce the likelihood of its development:
- exercise of moderate intensity several times a week: walking, yoga, dancing, swimming, etc.
- moderate, but constant and various types of mental stress: using puzzles, crosswords and other intellectual games, reading complex literature, playing a musical instrument, etc.
- Good nutrition: including a wide variety of vegetables, fruits, whole grains and seafood in your diet
- Caring for the cardiovascular system: controlling body weight and blood pressure, quitting smoking and alcohol abuse, practicing stress management and relaxation techniques
- communicating with different people, expanding the circle of acquaintances and interests
- avoiding head injuries: wearing helmets while cycling, using seat belts, avoiding sports involving constant blows to the head (martial arts, rugby, etc.)etc.).
The aforementioned preventive measures can also be part of mitigation therapy when dementia has already been diagnosed and it is required to prevent its progression. A variety of mental activities, combined with the right physical activity and a balanced diet, help preserve the brain and help slow dementia.
Guidelines for the clinical study of drugs for the treatment of Parkinson’s disease
This document should be considered as a general guideline for drug development for the treatment of Parkinson’s disease and is inextricably linked to other EMA and ICH guidelines that may address this topic and patient populations.
Depending on the stage of the disease in Parkinson’s disease, a number of indications for use are traditionally distinguished. Basically, they are aimed at reducing the severity of certain symptoms of the disease. The clinical development plan for these indications is clearly defined. Confirmation of efficacy and safety is based on double-blind, parallel design (placebo and active control) studies.
Recent advances in the basic sciences and molecular biology of neurodegenerative diseases, including Parkinson’s disease, have stimulated interest in drugs that modify their course.While it is impossible to recommend a specific design, the number of studies on drugs aimed at slowing the progression of the disease is increasing. In the study of such drugs, it seems advisable to use a two-stage scheme: initially, the possibility of slowing the progression of the disease should be shown, and then the effect on the underlying pathological process should be established.
Parkinson’s disease (PD) is a common neurodegenerative disease characterized by the degeneration of heterogeneous populations of nerve cells (mainly dopaminergic neurons) with damage to various neurotransmitter systems and various parts of the nervous system.The degeneration process begins with the anterior olfactory nucleus and the nuclei of the caudal parts of the brain stem, and then spreads to the overlying structures. Degeneration of pigment neurons of the compact part of the substantia nigra leads to the appearance of the most characteristic motor manifestations of the disease. For a pathomorphological diagnosis, it is necessary to have eosinophilic cytoplasmic inclusions (Lewy bodies) in the remaining cells of the pigment nuclei and other parts of the brain. However, Lewy bodies are not unique to PD.They are also found in Alzheimer’s disease and in old age.
The estimated incidence of PD is 4.5–16 per 100,000 population per year. Before the age of 50, PD is relatively rare. With age, the incidence increases from 5 per 100,000 in the 45–49 age range to 90 per 100,000 population / year among people over 75 years of age. The prevalence of the disease is 18–328 per 100,000 population. The overall prevalence of PD among people 65 years of age and older is 1.6%.The prevalence also increases with age, from 0.6% in people 65–69 years old to 3.5% in people 85–89 years old.
The clinical diagnosis of PD is made when the patient has bradykinesia and at least one of the following symptoms: resting tremor, muscle rigidity, and postural abnormalities (main symptoms). The diagnosis of PD requires exclusion of other causes of parkinsonism, for example, progressive supranuclear palsy, multisystem atrophy, drug-associated parkinsonism, and post-encephalitic parkinsonism.Misdiagnosis, especially in the early stages of PD, is quite common. However, about 75% of PD diagnoses are reasonable if 2 of the 4 main symptoms are present and no other neurologic symptoms are present. In addition, magnetic resonance imaging may be useful to rule out other parkinsonism syndromes. In 15–25% of cases of clinically diagnosed PD, it is not confirmed by histopathological examinations. The role of biomarkers in the diagnosis of PD remains unclear.
Other symptoms that may occur as the disease progresses include autonomic disturbances (sialorrhea, seborrhea, constipation, urinary and sexual dysfunction, orthostatic hypotension, hyperhidrosis), sleep disturbances, and sense of smell and temperature perception.
In 45% and 35% of cases, PD patients, respectively, have symptoms of depression and cognitive impairment. There are no clear clinical signs that distinguish depressive symptoms in PD from depression itself.With regard to cognitive impairment, their nature has many clinical and neuropathological features in common with other dementia disorders. Dementia in Parkinson’s disease (DPD) clearly correlates with dementia in diffuse Lewy body disease (BTL), but may also have many similarities with Alzheimer’s disease. Most neuropathological studies have shown the simultaneous presence of amyloid plaques characteristic of Alzheimer’s disease in patients with ALD. Despite the fact that in the early stages of these diseases the spectrum of cognitive impairments may differ, as the pathological process progresses, the clinical picture of cognitive disorders in DLD and Alzheimer’s disease becomes similar.The question of the independence of dementia with Lewy bodies and LBD remains open.
PD is characterized by slow progression. In 25% of cases, severe disability or death occurs, as a rule, within 5 years, in 65% – within 10 years, and in 80% of patients – within 15 years from the onset of the disease.
Ideally, treatment should stop the course of the neurodegenerative process and slow the progression of the disease. However, the mechanisms underlying the death of dopaminergic cells in PD remain unknown.To date, there is no pharmacotherapy that can significantly slow down the progression of this disease.
The current approaches to the pharmacological treatment of PD are symptomatic. It is based on the improvement of impaired dopaminergic neurotransmission. Depending on the characteristics of the clinical picture, patients in the early stages of PD can begin treatment with either dopamine receptor agonists or a dopamine precursor (levodopa).
In the early stages of PD, treatment of patients usually begins with the use of dopamine receptor agonists.If, as the disease progresses, their isolated use to control symptoms is not enough, levodopa drugs are added to therapy. In advanced stages of PD, most patients receive both levodopa drugs and dopamine receptor agonists.
As the pathological process progresses, motor complications develop. They are often referred to as levodopa-induced motor complications. However, the mechanisms leading to the development of these manifestations are not fully understood.It seems most likely that the effect of levodopa drugs changes due to a progressive decrease in the number of dopaminergic cells, since there is no evidence of a negative effect of levodopa drugs on the progression of the disease.
Dose-dependent factors that limit the use of levodopa drugs include the development of involuntary movements (dyskinesias, dystonia, choreoathetosis), undesirable mental reactions (for example, hallucinations, delirium, psychosis), and autonomic disorders (for example, orthostatic hypotension).Dopamine receptor agonists act directly on dopamine receptors. However, compared to levodopa drugs, they are relatively less effective and more likely to lead to the development of mental and autonomic disorders.
Other groups of drugs, such as monoamine oxidase and catechol-O-methyltransferase inhibitors, anticholinergics and glutamate modulators, can act as alternatives, but are most often used as adjunctive therapy to levodopa and other dopamine receptor agonists.
Non-pharmacological treatments include deep brain stimulation and neuronal implantation. Deep brain stimulation has been used in a limited number of patient groups. Neuron implantation is more of a research nature.
This document focuses on PD with a brief mention of BPD and depression in PD.
This guideline aims to provide guidance on drug research for the treatment of Parkinson’s disease.It is inextricably linked to Directive 2001/83 / EC as well as current and future EC and ICH guidelines, in particular:
Research in special groups: elderly (ICH E7);
Population exposure to assess the clinical safety of drugs for the long-term treatment of non-life-threatening conditions (ICH E1);
General Clinical Research Issues (ICH E8);
Guidelines for clinical trials in small populations;
Statistical Principles for Clinical Research (ICH E9);
Selection of control group for clinical trials and related questions (ICH E10);
Guidelines for the study of drug interactions;
Pharmacokinetic studies in humans;
Pharmacokinetic and clinical evaluation of modified release dosage forms;
Data on dose-response relationship to justify drug registration (ICH E4);
Guideline on medicinal products for the treatment of Alzheimer’s disease and other dementias (CPMP / EWP / 553/95, Rev.one).
They are aimed at assisting the applicant in the interpretation of certain problems associated with drugs used for PD.
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90,000 what is the difference, features and symptoms of diseases
Progressive brain lesions are accompanied by a violation of many functions necessary for a normal human life in society.Alzheimer’s type dementia is one such disease. In order to timely detect the disease and start treating it, you need to have an idea of the pathology, its differences with Pick and Alzheimer’s disease.
What is Alzheimer’s type dementia?
Dementia is a syndrome of progressive or chronic brain damage, during which higher cortical functions are impaired. These include memory, orientation in space, thinking, understanding of the environment, the ability to learn, speech.At the same time, the consciousness of the victims is not darkened.
To establish a diagnosis, the clinical picture of the disease must be noted for at least six months. A more progressive onset of the disease is also possible. The development of dementia in Alzheimer’s disease is promoted by:
- long-term use of certain drugs;
- lack of vitamins in the body;
- metabolic disorders against the background of liver and kidney pathologies;
- hormonal imbalance;
- vascular diseases;
- lesions by infectious agents of bacterial and viral etiology;
- Frequent stress, depressive conditions;
- regular consumption of alcoholic beverages;
- craniocerebral trauma with damage to the structures of the brain;
- benign and malignant neoplasms.
Distinguishing vascular dementia from Alzheimer’s disease
It is important to know how dementia differs from Alzheimer’s disease. If a person has vascular dementia, the ability to normally perceive and analyze information is impaired. Among the causes of pathology, peripheral vascular diseases, myocardial diseases, hypertension, as well as increased cholesterol levels are most often observed.
Alzheimer’s disease is a serious neurological disorder of the brain that causes dementia.
The etiology of the development of Alzheimer’s disease is associated with a person’s age, genetic predisposition, and general poor health.
In addition, the disease is characterized by a slow course, due to which pathological processes develop over the course of many years.
Distinguishing dementia from Pick’s disease
Patients who suffer from dementia in combination with Pick’s disease are able to continue learning and remembering events from their lives.
In patients with Alzheimer’s dementia, loss of cognitive function is one of the first symptoms.
During Pick’s disease, short, episodic hallucinations are possible, which go away on their own. Also, patients have outbreaks of nervousness and excitement.
Stages of dementia of the Alzheimer’s type
The initial stage of the disease is accompanied by minor clinical symptoms. Patients experience memory impairment, in which they forget the meanings of some words, as well as certain events in life.
They find it difficult to analyze the situation and think abstractly. The patient realizes that his condition is deteriorating, as a result of which he has psychological disorders.
They are accompanied by irritability, agitation, alcohol cravings and insomnia.
At an early stage in the development of pathology, human mimicry lends itself to dramatic changes, he is characterized by a surprised facial expression, an open mouth, raised eyebrows and rounded eyes. Patients forget about hygiene procedures, they are poorly oriented in space, even in familiar places.It is difficult for them to write and count, and physical activity slows down significantly.
Disorders of speech, writing and reading are characteristic of the moderate form of the disease. The coordination of movements is significantly impaired. Patients do not recognize their loved ones and relatives, and also practically do not remember any events in life. Most of them have irritability, which is replaced by apathy. Patients cannot find the right words or are completely silent.
The severe course of the disease is accompanied by changes in the patient’s personality. He does not remember who he is, and also does not give an account of what is happening around. Such people are inactive, silent. They often have tremors and delusional disorders.
Patients suffering from moderate to severe disease are completely dependent on the help of others. It is forbidden to leave them alone so that they do not harm themselves or other people.
To establish a preliminary diagnosis of dementia associated with Alzheimer’s disease, the patient must visit a neurologist.After collecting a general and family history, the doctor proceeds to examine the patient, as well as conduct a number of neuropsychological tests.
In order to confirm the diagnosis, the doctor prescribes instrumental and laboratory diagnostic methods. Among them, the most effective are:
- general and biochemical blood test;
- blood test for glucose and B vitamins;
- biochemical analysis of cerebrospinal fluid;
- computed and magnetic resonance imaging.
As an additional diagnostic method, the study of genetic material for the presence of mutated genes is used. The functionality of the endocrine organs is also checked.
The principles and methods of treatment are selected individually, taking into account the age of the patient, the stage of the disease and the presence of concomitant pathologies. They are aimed at treating Alzheimer’s dementia, as well as eliminating the consequences of degenerative changes in nerve tissues.
Complex treatment is carried out by taking medications that stimulate blood circulation and metabolism in the structures of the brain. In parallel, this is complemented by physiotherapy, exercise therapy and a special diet.
Useful information In combination with the main treatment, doctors carry out the prevention and therapy of diseases developing against the background of dementia. These include hypertension, atherosclerosis, obesity, diabetes mellitus, depressive conditions.For the general strengthening of the body, antioxidants and vitamins are prescribed. In the middle and severe stages of the disease, drugs with a pathogenetic effect are used.
Alzheimer’s dementia cannot be completely cured. Timely started therapy will improve the patient’s quality of life, increase its duration, and also ease the responsibilities of loved ones to care for him. At a certain stage, even these actions cease to give the desired effect, as a result of which the patient’s personality is completely amenable to changes.He literally ceases to be himself.
Alzheimer’s and dementia, Pick, Parkinson’s disease: the difference and similarities of diseases, their symptoms and signs
Alzheimer’s disease and other similar diseases are various forms of senile dementia, leading to impaired brain activity and dementia.
What are the diseases that are similar to Alzheimer’s disease, how do they differ, is there a significant difference between them?
- However, accurate diagnosis of this ailment is difficult – observation is required, and only the dynamics of development in conjunction with the research results make it possible to establish the final diagnosis.
- Alzheimer’s syndrome does not appear suddenly , dementia with it develops gradually: the symptoms appear first in forgetfulness, gradually worsening, then in difficulty in communication, speech impairment.
- Genetic tests show that some DNA fragments are altered, and MRI of the brain confirms changes in the size and configuration of the medulla.
From the first symptoms to irreversible processes and destruction of personality, a period of time from 1 year to 10 years can pass.
The general state of health can remain satisfactory, without serious chronic ailments.
Alzheimer’s syndrome most often affects the elderly , but it is not a deadly disease: old people die from concomitant chronic diseases.
Similarities and differences
SD and its development
How is dementia different from Alzheimer’s? Vascular dementia is a condition that is a consequence of vascular diseases such as atherosclerosis, or the result of a stroke.
With ischemic stroke, the bloodstream is blocked by a thrombus, which impedes blood flow.
If a stroke is caused by a ruptured vessel, then the blood supply to some parts of the brain is almost completely cut off. Such processes lead to the development of dementia, regardless of age.
Manifestations of vascular dementia (DM) – memory loss, speech impairment, up to a complete absence of coherent words, and often – paralysis of the limbs. The mortality rate reaches 50%.
Typical symptoms of this ailment are as follows:
- memory loss – forgetfulness appears rarely at first, then more and more often, glimpses of reason and recognition of loved ones happen less and less, then disappear altogether;
- speech impairment: the old man forgets the thread of the conversation in mid-sentence, then only repeats the last words of the interlocutor, later completely stops pronouncing the words;
- complete lack of interest in previously favorite topics;
- the disappearance of a sense of natural bashfulness.
90,053 loss of skills;
Losing orientation and not remembering themselves, sick old people often leave home and do not know how to return.
An elderly person who gradually fell into insanity stops eating normally, weakens and turns into a vegetable: he does not feel the need for natural functions, is not able to complain about anything or ask for something.
The disease gets worse over a long time , and the “vegetable” stage is the last, the most severe.
An edema patient most often suffers from pneumonia, which turns into pulmonary edema, or falls into a coma.
- The similarity of these diseases is that they affect the brain , and most often elderly people who end their lives in dementia are susceptible to Alzheimer’s and Parkinson’s diseases.
- In fact, these are different diseases, the symptoms of which are not the same.
- What is the difference between Alzheimer’s and Parkinson’s? With Parkinson’s disease, at first, there are no memory lapses, speech impairments, loss of life skills, manifestations in the initial stage are as follows:
- retardation, as it were, slowness in actions, including in speech;
The person gradually begins to bend, moving in slow motion and not straightening when walking. There is pain in the joints, flexion of the limbs is difficult, hands and head begin to tremble.
In the course of time, the patient stops walking, becomes unable to take care of himself, which is aggravated by the intensified tremor.
How else is Alzheimer’s disease different from Parkinson’s? Parkinson’s disease distorts its victim’s face into a mask.The sick person will be bedridden with all the ensuing consequences.
It becomes difficult for him to pronounce words, it is difficult to swallow, salivation begins. Helplessness and dementia are the result of this terrible disease.
- In Pick’s disease, patients behave like young children : they lose a sense of reality, the cause-and-effect relationship between actions is disrupted.
- For example, such an old man doesn’t need anything to leave everything and go somewhere, but not because he got lost and forgot the way.
- The patient, if still working, can leave the workplace without warning, allowing absenteeism.
- A person commits acts that harm his financial situation, but there is no memory loss, unlike the elderly with Alzheimer’s disease.
“Peak” patients remember events perfectly, they are oriented in time and space, but their thinking apparatus, which controls actions and actions, is amazed, hence the illogical, damaging the reputation and wallet actions.
The speech apparatus is also impaired, as there are such manifestations:
- the repetition of the same word or phrase is noted, as if the record has “stuck”;
- speech becomes scarce, as vocabulary dries up;
- there is a lack of words, such a patient cannot be called a talker.
If in Alzheimer’s disease the old man quickly learns to write and read, then those affected by the disease also reach the peak of this stage, but much later.
Mental disorders in patients with Pick’s disease do not show signs of obvious insanity and are expressed as follows:
- there are outbursts of sharp excitement, quickly fading away;
- the presence of hallucinations, although episodic.
90,053 statements contain nonsense-like fabrications;
Such manifestations are completely uncommon for Alzheimer’s syndrome . Accurate diagnosis is possible after analysis and CT, MRI studies.
- Differences between Alzheimer’s disease and Parkinson’s disease, Pick and vascular dementia:
- If you notice memory, speech and other problems in your relative , you should rush to the professionals in the field of neurology, psychiatry in order to identify the form of senile dementia as soon as possible and start treatment.
- It is impossible to completely stop the process, but there is a chance to slow down the development of dementia and the transformation of a loved one into a complete senile person.
How dementia differs from Alzheimer’s
Have you ever wondered what is the difference between dementia and Alzheimer’s disease? Or do you still mistakenly believe that they are the same thing?
Let’s try to figure out what the differences are. In short, it’s like the difference between a high fever and the flu. Fever is not a disease, but a symptom that occurs when you get the flu. But the presence of a high temperature is possible with acute respiratory viral infections, bronchitis, pneumonia, rheumatism, or acute inflammatory diseases, for example, of the bladder and kidneys.
So dementia is, first of all, not a disease, but a syndrome (a set of symptoms) caused by organic damage to the brain (usually of a chronic or progressive nature), in which many cognitive functions are impaired. These include memory, thinking, orientation, understanding, counting, learning ability, speech and judgment.
The symptoms of dementia are caused by various diseases that affect the brain. There are more than 130 diseases in the world that cause impairment of the functions of the cognitive apparatus.
The most common conditions that cause dementia are:
- Alzheimer’s disease (accounts for about 70% of all manifestations of dementia)
- Vascular dementia (the result of cerebrovascular accident due to stroke – 20% of manifestations of dementia)
- Parkinson’s disease
- Frontotemporal degeneration (Pick’s disease)
- Huntington’s disease (Huntington’s chorea)
- Diffuse Lewy body disease
These diseases were combined into one group called “neurodegenerative diseases” due to the similarity in many ways.
There is a widespread belief that dementia is an irreversible decline in cognitive functions, loss of short-term memory caused by organic damage to the brain. However, this is not entirely true.
Some of the diseases that lead to dementia are curable. If treatment is started on time, many of their cognitive functions can be preserved. Therefore, at the first sign of dementia, you should always see your doctor.
What is the main difference between Alzheimer’s disease and other diseases that cause dementia?
Different neurodegenerative diseases have different first signs of dementia.They depend on which part of the brain is affected. Then, with the development of the disease itself, these differences are erased.
In Alzheimer’s disease, short-term memory is the first to suffer. The disease develops slowly and can take several years. But memory degradation is going on steadily.
In Pick’s disease, the frontotemporal regions of the brain are affected. This disease often occurs before the age of 65 and refers to dementia with an earlier onset. At the onset of the disease, it is not memory disorders that predominate, as in Alzheimer’s disease, but disorders in behavior, speech and emotional disorders, difficulties with planning and solving various problems.
Vascular dementia occurs as a result of acute circulatory disorders of the brain, mainly after a stroke or injury. Some part of the brain is destroyed. Therefore, deterioration occurs suddenly, more abruptly and proceeds in stages. In the future, with proper therapy and rehabilitation, dementia may not worsen, and in some cases even be compensated. Healthy brain cells take on the burden of damaged cells. This is where vascular dementia differs from Alzheimer’s, in which deterioration is usually slow and persistent.
In Parkinson’s disease, short-term memory suffers, as in Alzheimer’s disease. Difficulties appear with concentration of attention, comprehension of what is happening. As the disease progresses, motor and movement disorders, stiffness when walking, and tremors of the limbs are detected. It occurs due to the fact that the parts of the brain that are responsible for movement are primarily affected.
There is a widespread belief that dementia occurs naturally as the body ages.A person begins to freak out from old age. The head doesn’t work anymore. But this is a deeply false statement.
Dementia is not a normal manifestation of old age. Behind any manifestation of senile dementia is either Alzheimer’s disease or some other disease.
This is very important to understand because many forms of dementia cannot be cured. Correct diagnosis at an early stage makes it possible to slow down the progression of the disease and improve the quality of life of a sick person.
Differences between dementia and Alzheimer’s disease – what’s the difference? Center for treatment and rehabilitation in Moscow
Dementia occurs due to severe brain disorders caused by various diseases.Alzheimer’s disease is a severe neurological disorder of the brain that causes dementia.
Comparison of vascular dementia and Alzheimer’s disease
The reason for the development of vascular dementia is a heart attack, stroke, heart defects, diabetes mellitus, coronary heart disease and other factors. Vascular dementia can develop after an acute process or develop gradually due to slow blood circulation in the brain.
It has been proven that with constant training of the mind, physical activity, the likelihood of Alzheimer’s disease decreases.An important role in the development of the disease is played by the emotional state, the presence of stressful situations, heredity.
It is often difficult for doctors to determine what type of dementia a patient has, since a mixed type of disease is diagnosed, when Alzheimer’s dementia is accompanied by vascular dementia. A complete diagnostic study allows you to prescribe an adequate treatment for the patient.
The equipment of the Yusupov hospital meets world quality standards. Research on modern equipment, laboratory tests can determine the type of dementia, the state of the patient’s brain, the severity of the disease.
Competent diagnostics helps the neurologist to choose the right direction of the patient’s treatment, to alleviate his condition.
Difference between diseases
When diagnosing various types of dementia and Alzheimer’s disease, the differences between these pathological disorders allow differentiating diseases and prescribing adequate treatment for the patient. Dementia is often a concomitant disease of Parkinson’s disease. Dementia is associated with Alzheimer’s disease.
The difference between Alzheimer’s disease and dementia is that Alzheimer’s disease always leads to dementia (senile dementia), but dementia is not always caused by Alzheimer’s disease – there are a number of other factors and causes that cause dementia.
What is the difference?
There are definite differences between dementia and Alzheimer’s disease. The difference in the course of illness is as follows:
- Unlike Lewy body dementia, Alzheimer’s disease does not manifest itself in the early stages of development with hallucinations, increased muscle tone and sleep disturbances. Dementia with Lewy bodies is characterized by impaired motor function, coordination, and spasmodic memory lapses. The patient may not remember the relatives, and the next day they all call by name.Memory loss in Alzheimer’s disease occurs gradually, in the later stages, a person completely loses memory. Alzheimer’s disease occurs most often in women, dementia with Lewy bodies – in men;
- with dementia, the patient has a speech disorder. Dementia is characterized by personality changes in the early stages of the development of pathology. Pick’s disease is characterized by atrophy of the cerebral cortex in the region of the temples and frontal lobe, life expectancy is shorter than in Alzheimer’s disease;
- dementia accompanies Alzheimer’s and Parkinson’s.Parkinson’s disease, like Lewy body dementia, is an impaired motor function, unlike Alzheimer’s disease.
It is important to timely diagnose the disease and differentiate it from other diseases. In the neurology clinic of the Yusupov Hospital, experienced doctors are involved in the treatment of Alzheimer’s disease, dementia, multiple sclerosis and other diseases of the nervous system. You can make an appointment with a neurologist by phone.
- ICD-10 (International Classification of Diseases)
- Yusupov Hospital
- Gavrilova S.I. Mental disorders in primary degenerative (atrophic) processes of the brain. // Guide to Psychiatry / Ed. A.S. Tiganova. M., 1999.T. 2.
- Medvedev A.V. Vascular diseases of the brain // Guide to psychiatry / Ed. A.S. Tiganova. M., 1999.T. 2.
- Korsakova N.K., Moskovichyute L.I. Clinical neuropsychology. M., 2003 (Chapter 5 “Neuropsychological syndromes in aging”).
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Early signs of dementia and the difference between dementia and Alzheimer’s
Dementia is not a disease, but a syndrome characterized by a wide range of symptoms that cause gradual impairment of memory, thought process, communication, reasoning, judgment and visual perception.Dementia is a global health crisis that affects 47.5 million people worldwide, with 7.7 million new cases occurring each year.
Types of dementia Alzheimer’s disease is the most common type of dementia, accounting for about 50-70 percent of all cases. It often results in a loss of connection between brain cells, resulting in abnormal protein problems. These deposits, in turn, cause brain cells to dry out and ultimately lead to their death.
- Vascular dementia accounts for about 25 percent of cases and is caused by an inadequate supply of oxygen to the blood in some parts of the brain.
- Frontotemporal dementia is the most common type of dementia in people under the age of 65 and mainly occurs when the frontal and temporal lobes of the brain are damaged.
- Mixed dementia is a type of dementia that exhibits changes in the brain associated with more than one type of dementia.
Dementia and Alzheimer’s Disease – Difference Most people are under the false impression that dementia and Alzheimer’s are one and the same and tend to use the two terms interchangeably. However, the fact is that they are different from each other.
While dementia is an umbrella term for various brain disorders, Alzheimer’s is just one of these disorders.
Alzheimer’s disease is a progressive brain disease characterized by death and damage to brain cells, especially those associated with memory.
The debilitating symptoms of Alzheimer’s disease, such as memory loss, disorientation, impaired judgment, and deficits in decision making, have been attributed to build-up of plaques and tangles in the brain.
There are many risk factors for Alzheimer’s disease, from old age to genetics.
Early signs of dementia The early signs of dementia are often unclear. Because the symptoms associated with dementia develop gradually, they often go unnoticed in the early stages.Therefore, people either do not recognize the signs, or mistakenly attribute them to old age.
The signs and symptoms of dementia vary by type and from person to person. Thus, it is imperative to watch out for any possible warnings that indicate that something might be wrong with the person.
Below is a list that covers the most common symptoms:
1. Memory problems Most often, these memory changes refer to such small things as forgetting about appointments, struggling to remember what you ate for breakfast or repeatedly asking the same questions, etc.d.
2. Communication difficulties People with dementia often face language problems and struggle with the inability to find the right words to express their thoughts and feelings. They may also find it frustrating to follow conversations and stories.
3. Impaired judgments A person with dementia may struggle to make the right decisions because of their inability to reason properly. For example, they may make bad judgments when balancing budgets or dealing with money.
4. Mood swings Patients with dementia are also prone to mood swings and personality shifts. They may become depressed, show confusion, or do things that seem out of character. Most are caused by memory loss and mental impairment caused by the disorder.
5. Spatial disorientation Difficulty in following instructions or directions, inability to recognize familiar places and problems with depth perception are also common symptoms of dementia.
Source Translation and adaptation – Fithacker
Alzheimer’s and other types of dementia: how are they different?
Until twenty or thirty years ago, it was impossible to conduct research or take pictures of the brain that would show how this organ works. With the development of medicine, this has changed, and today we have much more knowledge.
Doctors diagnose dementia when two or more areas of our brain are affected. Getting sick means that the brain shrinks, that is, it becomes smaller, and this, in turn, causes changes in cognitive functioning and behavior.
Thus, dementia impairs the ability to reason logically. As a result, daily activities become difficult, the patient cannot dress normally, find a favorite glass in the kitchen cupboard, or look in vain for a toilet in his own home. He can easily get to a nearby bakery, but he has problems getting home.
Sometimes the patient does not understand that someone is talking to him or refuses to participate in the family dinner.He remembers that he has children, but he ceases to recognize them by their faces; only their 30-year-old image remains in the brain. Not noticing loved ones, the patient can turn to them with the words, as to strangers: “What are you doing in my house? Who let you in here ?! ”
Why did I come here?
Forgetfulness can happen to anyone. We get up from the chair, we want to make coffee, so we go to the kitchen. On the way, the phone rings, we talk a little, go into the kitchen … and we are struck by the question: “Why did I come here?”, “What was I looking for?”.Only after a while, when we return to the chair, we receive the epiphany: “Coffee!”
Childish tantrums: How to calm a child during a tantrum
Such situations are the norm, everyone experiences them many times. Stress, excess of responsibilities, overwork, weakening of the body or illness. But, it is worth a little rest, relax, and we are back in shape.
However, if we start putting objects in strange places, and this happens more and more often, we face problems in managing money, although we have always been a model of thrift and common sense in the family, and pie recipes that have been known for many years suddenly disappear from our memory – this is a bad sign.
Then the described behavior is no longer ordinary forgetfulness, although it is not yet dementia.
Characteristics of pathology
Alzheimer’s type dementia is a persistent, progressive deterioration in cognitive abilities and neuropsychological state, which causes concomitant changes in behavior, the development of depression, phobias, neuroses.
Dementia is a clinical symptom complex, indicating a pronounced violation of the cognitive function, which impedes the performance of everyday and professional duties.Severe memory impairment often manifests itself in the later stages of the course.
Alzheimer’s disease and dementia are synonyms, there is no difference between them, as can be seen by looking at the G30 code in the ICD-10 (international classification of diseases).
Pathology develops due to the formation and increase in the number of amyloid (protein) plaques and neurofibrillary tangles (areas of protein accumulation) in the brain tissues.
Dementia criteria include memory impairment – inability to memorize new material, difficulty in reproducing previously learned, assimilated information.
Another decisive sign is a violation of such cognitive functions as the ability to think logically, plan, organize their actions.
The fact of the presence of disorders and the severity of manifestations are revealed using neuropsychological tests.
It is important to take into account that pathology is characterized by a deterioration in cognitive abilities against the background of preservation of consciousness. To confirm the diagnosis, it is necessary to have one of the signs (or their combination): apathy, irritability, emotional lability, antisocial behavior disorder.The listed signs should be observed for at least 6 months.
Obviously, dementia manifests itself both mentally and physically. Others notice unusual behavior, hear irrational stories, and stop understanding what they are being told. We begin to see their anger or loss of patience with having to answer all the same questions.
Dementia often causes mood swings. Sometimes we clearly remember something, so that after a while we completely forget – even when it comes to the dinner we ate a minute ago.In a minute we will angrily ask why we are hungry, and in the evening we will complain about it to our neighbor.
It happens that a person with dementia asks the same question many times, even hundreds of times. Or reliably and in detail tells about what happened several decades ago. We talk for hours, often use the same words and sentences, and it starts to sound like a “worn-out record”.
Knowing that the behavior of a loved one, which is annoying – for example, repeating a question dozens of times – arises from changes in the brain, helps to show understanding and patience.
Comparison of dementia in Alzheimer’s with other forms
The difference between Alzheimer’s and other types of dementia is easy to detect. You just need to know what features are characteristic of other pathologies accompanied by the development of dementia.
Senile dementia is considered as a general definition for all kinds of intellectual disorders associated with the degeneration of brain cells with aging.
Senile dementia differs from Alzheimer’s, because dementia in the syndrome is only one of the forms of age-related dementia, which includes disorders in Pick, Parkinson’s diseases, vascular and other pathologies, as well as physiological dementia that develops during aging.
Senile dementia has many causes that can act alone or in combination:
- alcoholism and drug use;
- vascular pathology;
- strokes and heart attacks;
- pathology of the thyroid gland;
- other diseases of various body systems.
Important! The manifestation of dementia depends on the underlying cause!
Senile dementia Alzheimer’s is the most common type of age-related dementia (about 60-70%).The “usual” dementia in the elderly is characterized by the gradual death of brain neurons.
The very first short-term memory is affected, then difficulties arise in communication and performing actions familiar to a person. The progression of senile dementia can take years and cannot be stopped.
With Pick’s disease
Dementia and Pick’s disease are also closely related. In people with this pathology, however, memory is not impaired at all. This is one of the characteristic differences from dementia in Alzheimer’s, when memory disorder is one of the first and main symptoms.Thanks to this feature, it is possible to distinguish between these two pathologies already in the early stages.
Dementia in Pick’s disease is also characterized by episodes of short-term hallucinations that arise and end spontaneously. Relatives of patients often notice outbreaks of sudden excitement in them. Such phenomena in patients with Alzheimer’s occur only in rare cases.
Pick’s disease is characterized by a change in the patient’s personality at the earliest stages. The person becomes angry and suspicious.It is also a diagnostic sign, as in Alzheimer’s, personality disorders most often appear in the later stages of the disease.
Alzheimer’s dementia and vascular dementia have only a few small differences. Due to the similarity in the clinic, specialists sometimes use the concept of vascular dementia of the Alzheimer’s type. Differential diagnosis of BA and DM
|Feature||Vascular dementia||Alzheimer’s disease|
|Start||Abrupt or gradual||Gradual|
|Development||Slow, stepped, fluctuating||Gradual with imperceptible progression|
|Neurological disorders||Focal symptoms present||None or minimum|
|Memory||Violated slightly||Strongly violated already at the initial stages|
|Executive functions||Suffer early and hard||Lost at later stages|
|Type of dementia||Subcortical||Cortical|
|Neuroimaging||Subcortical white matter lesion||Predominantly atrophy of the hippocampus and temporoparietal cortex|
|Walking||Often violated in the early stages||Usually unchanged|
|Cerebrovascular history||Transient ischemic attacks, strokes, vascular pathologies||Vascular disorders are less common|
Pathology associated with vascular changes has some features:
- sharp and strong (almost to a minimum) decrease in the ability to perceive and analyze information;
- the causes of pathology are most often: stroke, cerebral ischemia, peripheral vascular disease, cardiac dysfunctions, high blood pressure, high cholesterol levels;
- there is no connection with old age and heredity, which makes it possible to distinguish dementia from Alzheimer’s disease;
- rapid development if the cause of dementia is a stroke or other acute pathologies of the cerebral vessels;
- the presence of symptoms such as epileptic seizures and disorders of the bladder function;
- Sometimes there are periods of short recovery of functions.
All these features make it possible to differentiate dementia due to vascular disorders from Alzheimer’s pathology.
Dementia in Parkinson’s
Dementia in Parkinson’s disease is the second most common pathology after dementia in Alzheimer’s and Huntington’s disease. It develops as a result of the death of nerve cells in the areas of the brain responsible for memory, psyche, the ability to learn and perceive information. The patient’s consciousness with all these changes, however, remains clear.
Dementia and Parkinson’s are characterized by very slow progression in most cases. Initially, mental abnormalities appear in the form of apathy and depression, then – impaired attention, illegibility of speech, and only then – memory disorders. The motor symptoms of dementia in Parkinson’s are also noted:
- Due to the weakening of the facial muscles, the face looks like a mask;
- Stiffness and muscle tension;
- pronounced stoop, shuffling and unsteady gait;
- retardation of movements;
- Sharp and severe deterioration of handwriting.
Parkinsonism includes tremors of the limbs and jaws and other similar disorders. Such movement disorders are not common in Alzheimer’s syndrome. Parkinsonism and dementia, which speak of damage to the nervous system, are almost 100% likely to indicate the diagnosis of Parkinson’s disease.
Lewy body dementia
This type of dementia is characterized by impaired motor functions, coordination, as well as spasmodic memory disorders, when the patient today does not remember his relatives, and tomorrow he can name them by name.And in patients with Alzheimer’s, memory loss occurs gradually, until it is completely absent in the final stages.
In pathology with Lewy bodies, dementia differs from Alzheimer’s disease by the appearance of hallucinations, increased muscle tone and sleep disturbance already in the early stages. Also, the differential criterion is that Alzheimer’s syndrome is more often detected in women, and lesion with Lewy bodies – in men.
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Effect of dementia on the eyes
As a result of the disease, visual abilities are also significantly changed.What we see occurs essentially in the brain, more precisely, in its back, called the occipital lobe. Each eye transmits the image “upside down”, then the brain turns everything upside down and composes everything into one whole – then we see the face.
In the course of changes, such as dementia, we first see the world around us as through a diving mask, then as through binoculars, and then the brain ceases to recognize what the observed objects are for. In the last stage of dementia, we see how through the crosshair.In this case, you do not need to have any problems with the eyes – this is the question of how the brain processes the information received from the eyes.
Features of treatment
A psychiatrist treats Alzheimer’s disease in the early stages, when the first signs of memory and attention impairment appear. A feature of medications (Dopenesil, Memantine) at this stage is to slow down the progression of symptoms by facilitating the formation of interneuronal connections. With the timely start of treatment, the patient retains practical skills and orientation in space and time longer.
A feature of the late stage is quality care and safety control. Patients need communication, the organization of rehabilitation activities, walks, quality food.
Important! Relatives need to spend time with the sick person and maintain emotional attachment.
Raising your voice? No thanks
Hearing from dementia does not worsen, although hearing problems associated with age or other medical conditions may appear. It happens that the first symptoms of dementia, for example, misunderstanding of words, are mistaken for hearing impairment.
A person with dementia does not respond to questions from loved ones as quickly as before, so they begin to raise their voice or speak more clearly. But, the fact is that he hears, but cannot understand what he hears.
This is part of a broader group of symptoms — those that will one day prevent you from recognizing yourself in the mirror.
What increases the risk of dementia?
Diseases of veins and arteries, high blood pressure, diabetes, high cholesterol, stroke, alcohol abuse, and physical and mental inactivity.
Unfortunately, medicine cannot explain most cases of dementia yet. According to statistics, when we reach 85 years of age, half of us will suffer from dementia, and the other half will become guardians.
90,000 NeuroDok – neurological clinic on Schadowstrasse in the city center of Düsseldorf, Germany
Diagnosis of dementia
Dementia is quite easy to define: its typical signs are certain changes in the behavior and character of a person, and further research can help to make an accurate diagnosis.
The memory loss associated with dementia can be determined by neuropsychological tests, one of the most commonly used of which is the 15-minute Mini Mental State Examination (MMSE) test.
In addition, there are also tests, the results of which complement the MMSE – tests for the early detection of dementia and depression, as well as rapid tests for the direct diagnosis of dementia. Information from close people and relatives of those suffering from dementia can also be of great help in identifying brain disorders.
To establish the causes of dementia, there are a number of other examinations. Basic diagnostics include examinations of the patient’s body, blood tests, as well as electrophysiological and visual procedures such as electrocardiogram, computed tomography and magnetic resonance imaging.
Depending on the suspected cause, further special diagnostic procedures, such as genetic testing, Single Photon Emission Computed Tomography (SPECT), or lumbar puncture, may be done.The most common form of dementia is Alzheimer’s disease, which is diagnosed by excluding all other possible causes.
The importance of neuropsychology in the diagnosis of dementia is revealed in the definition of dementia as a set of disorders of the brain functions. Neuropsychological diagnostic methods allow differentiated testing of various cognitive functions, thus giving an idea of certain types of brain performance and their impairments, regardless of each other.
An objective diagnosis of dementia requires a number of detailed neuropsychological studies that provide the necessary criteria for the diagnosis. The differentiated descriptions of cognitive impairments and preserved functions obtained in this way make it possible to determine the degree of progression of the disease and prescribe the optimal type of psychosocial therapy, as well as, accordingly, consult relatives and friends of the patient suffering from dementia.
In addition, detailed neuropsychological studies of dementia allow conclusions to be drawn about the type of dementia and the difference between dementia, etc.n. pseudo-dementia, which can be a consequence of depressive diseases.
90,000 Recognize dementia before it takes away memory
Treatment of dementia, how loved ones recognize the first signs of the disease, which doctors to go to, what social services can be provided to a family and an elderly person – these and other issues were discussed at a round table in the newspaper Strana Kaliningrad.
The heads of the Gerontopsychiatric Center and the Hospital for War Veterans, the Head of the Department of Guardianship, Guardianship and Social Services for Elderly and Disabled Citizens of the Ministry of Social Policy, representatives of the Ministry of Health of the region took part in a serious conversation.
Doctors explained that while medicine does not possess the means that can completely relieve a person from the disease, however, it is possible to improve the patient’s condition and alleviate the course of the disease if the diagnosis is made as early as possible.Any pathology that causes the destruction of brain cells can be called the cause of dementia. These diseases primarily include: Alzheimer’s disease; Parkinson’s disease; Pick’s disease; vascular diseases (strokes, heart attacks, etc.). Therefore, the relatives of an elderly person should, at the first signs: memory impairment, loss of interest in life or, on the contrary, manifestation of aggression, untidy appearance, reduced ability for abstract thinking and others, contact the clinic, at the first stage of the development of the disease, a neurologist will diagnose and prescribe the necessary treatment , you can also consult a gerontologist.
In the institutions of the Ministry of Social Policy, for any type of dementia, music therapy, occupational therapy and psychotherapy are used in working with patients in order to preserve the patient’s social and motor skills, various trainings that involve reading together, reproducing and discussing what has been read, discussing past events, viewing old photos. listening to retro music, as well as art therapy and music therapy. Service recipients are assisted in relieving feelings of helplessness and retaining functional functions.Also, to receive social services, elderly people or their family members can contact the social protection authorities at their place of residence.
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90,000 What to do if dementia develops
The doctor can tell you about the expected course of the disease. In the beginning, you can freeze Alzheimer’s with medication.For six, maybe even twelve months. Later, the disease will resume. But the patient will already benefit from therapy. The possibility of delay mainly arises in the early and middle stages, so the diagnosis must be made in a timely manner.
But this opportunity is often missed. Only every second patient with dementia is diagnosed. Fewer still receive appropriate therapy. This is partly because many patients – and sometimes their doctors – fear a dire diagnosis.Dementia is even more feared than Parkinson’s or stroke. Those who hear the diagnosis of Alzheimer’s disease fear that they will talk about him more than with him.
What’s more, dementia, including Alzheimer’s, is often not defined with absolute certainty. Doctors talk about the possibility, which today is high enough to diagnose the disease therapeutically. Moreover, modern medicine has appropriate research methods.
Dementia can be expressed in different ways
The diagnostic status for dementia is similar to that for cancer.It helps make treatment decisions, explain symptoms, and advise patients and their families. No dementia is like the other. Although, with most views, there are memory gaps. In any case, however, the range of possible problems is large: some patients gradually atrophy their vocabulary, others find it difficult to do simple actions such as pouring water into a glass. Apathetic behavior or misperceptions can also be signs of dementia.
The development of Alzheimer’s disease can be slowed down
The doctor can explain what is behind this.In more than 5% of cases, the causes can be cured: for example, if the thyroid gland is not working actively enough.
The most common explanation for Alzheimer’s is growths on nerve cells. With this development of events, the drugs already available do not help. Some patients may be taking part in trials of new drugs that will help slow the course of the disease.
Even poor circulation can cause dementia. It is often associated with diabetes or high blood pressure.In vascular dementia, drugs associated with Alzheimer’s have only a small effect. There are other rarer forms of brain degradation. A correct diagnosis can save the patient from unnecessary therapy.
Good and Bad Moments
The patient’s condition often changes: bright moments alternate with periods when the patient goes into illness. People with dementia have little room to mitigate these fluctuations. In some forms, such as vascular dementia, these ups and downs are especially common.Another example: if degradation occurs in the anterior regions of the brain, a hospitable family person can transform into a boor and rude person for no apparent reason. The thought that it might be a disease often comes late. Sometimes, unfortunately, the marriage first breaks up, then the diagnosis is made.
Choice of therapy
Regardless of the type of dementia, researchers attest to the effectiveness of psychological and social therapy. Treatment must be tailored to the patient.